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Abstract

PREDICTIVE VALUE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN WOMEN UNDERGOING INTRACYTOPLASMIC SPERM INJECTION WITH HIGH RISK FOR OVARIAN HYPERSTIMULATION SYNDROME

Ashraf T. Abd Elmouttaleb*, Doaa M. Abd-Elatif, Abrar G. Abd-Elfatah and Mohamed A. Albehiry

ABSTRACT

Background: Vascular endothelial growth factor (VEGF) is expressed
and produced by granulosa-lutein cells and is released into the
follicular fluid in response to human chorionic gonadotropin (hCG),
increasing capillary permeability. In addition, plasma VEGF levels
correlate with the clinical picture of ovarian hyperstimulation
syndrome (OHSS). Objective: This study aimed to investigate the
predictive value of serum VEGF at the day of hCG administration in
women undergoing intracytoplasmic sperm injection (ICSI) cycle and
in high risk of OHSS. Study design: Prospective cohort study.
Subjects and Methods: This study was performed on eighty women
with polycystic ovary syndrome with infertility and will undergoing
ICSI cycle. All women were subjected to routine practice of long
protocol for controlled ovarian stimulation (COS). The eighty subjects
included in this study were classified into two groups based on ovarian
response and E2 level before the day of hCG. Group A: Normal ovarian stimulation; thirty
women with E2 less than 3000pg/ml before the day of hCG administration. Group B: Ovarian
hyperstimulation (Coasting group); fifty women with E2 more than 3000pg/ml and count of
large follicles more than 20 follicles in each ovary with diameter > 17mm before the day of hCG administration, then those women coasted to reach E2 level less than 3000pg/ml at the day of hCG administration (as a high risk group suspected to ovarian hyperstimulation during induction of ovulation). Vascular endothelial growth factor concentrations in serum at the day of hCG administration were determined by enzyme- linked immune sorbent assay (ELISA). Results: The mean serum VEGF (pg/ml) for coasting and control groups was (296.9±15.53, 455.1±44.26) respectively which was significantly lowered compared to control group (p=0.0001). There were significant positive correlations between VEGF and both of follicle number (p=0.0133, r =0.4469) and mean of follicle diameter (mm) (p= < 0.0001, r =0.7515) in both ovaries of the control group. Also there were significant positive correlation between VEGF and both of follicle number (p=0.0027, r =0.4153) and mean of follicle diameter (mm) (p < 0.0001, r =0.5271) in both ovaries of the coasting group. Conclusion: Serum VEGF estimation after coasting at the day of hCG administration in high risk patient is recommended for early prediction of OHSS in addition to E2, follicle number and follicle diameter. Moreover, it can be used as an indicator of success of coasting. Further studies for measurement of total, free and soluble receptors of VEGF for clarification the role of VEGF in OHSS are recommended.

Keywords: Infertility, Ovarian hyperstimulation, vascular endothelial growth factor.


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